Timing of Trial of Void After Radical Hysterectomy: Long-Term Urinary Outcomes at Two Academic Tertiary Care Institutions.

IF 1.8 3区医学 Q3 OBSTETRICS & GYNECOLOGY International Urogynecology Journal Pub Date : 2024-08-14 DOI:10.1007/s00192-024-05888-z

Julia K Shinnick, Alex Rosenthal, Jennifer Pearson, Rubin Raju, Alicia Youssef, Erin M Lips, Christina Raker, Matthew M Scarpaci, John Occhino, Gretchen Glaser, Kyle Wohlrab, Katina Robison

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Abstract

Introduction and hypothesis: Many patients develop bladder symptoms after radical hysterectomy. This study compared urinary outcomes following radical hysterectomy based on trial of void (TOV) timing (pre-discharge TOV versus post-discharge TOV).

Methods: A retrospective non-inferiority study of patients at two academic tertiary referral centers who underwent radical hysterectomy between January 2010 and January 2020 was carried out. Patients were stratified according to timing of postoperative TOV: either pre-discharge or post-discharge from the hospital. Short-term urinary outcomes (including passing TOV, representation with retention) and long-term de novo urinary dysfunction (defined as irritative voiding symptoms, urgency, frequency, nocturia, stress or urgency incontinence, neurogenic bladder, and/or urinary retention) were extracted from the medical record. We hypothesized that the proportion of patients who failed pre-discharge TOV would be within a 15% non-inferiority margin of post-discharge TOV.

Results: A total of 198 patients underwent radical hysterectomy for cervical (118 out of 198; 59.6%), uterine (36 out of 198; 18.2%), and ovarian (29 out of 198; 14.6%) cancer. One hundred and nineteen patients (119 out of 198, 60.1%) underwent pre-discharge TOV, of whom 14 out of 119 (11.8%) failed. Of the post-discharge TOV patients (79 out of 198, 39.9%), 5 out of 79 (6.3%) failed. The proportion of patients who failed a pre-discharge TOV was within the non-inferiority margin (5.4% difference, p = 0.23). A greater proportion of patients in the post-discharge TOV group developed long-term de novo urinary dysfunction (27.2% difference, p = 0.005). Median time to diagnosis of de novo urinary dysfunction was 0.5 years (range 0-9) in the pre-discharge TOV group versus 1.0 year (range 0-6) in the post-discharge TOV group (p > 0.05).

Conclusions: In this study, pre-discharge TOV had non-inferior short-term outcomes and improved long-term outcomes.

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根治性子宫切除术后排尿试验的时机：两家学术性三级医疗机构的长期排尿结果。

导言和假设：许多患者在根治性子宫切除术后会出现膀胱症状。本研究根据排尿试验（TOV）时间（出院前排尿试验与出院后排尿试验）比较了根治性子宫切除术后的排尿结果：该研究对 2010 年 1 月至 2020 年 1 月期间在两个学术三级转诊中心接受根治性子宫切除术的患者进行了回顾性非劣效性研究。根据术后 TOV 的时间对患者进行了分层：出院前或出院后。我们从病历中提取了短期排尿结果（包括TOV通过、代表有尿潴留）和长期新排尿功能障碍（定义为刺激性排尿症状、尿急、尿频、夜尿、压力性或急迫性尿失禁、神经源性膀胱和/或尿潴留）。我们假设出院前TOV失败的患者比例将在出院后TOV的15%非劣效差范围内：共有 198 名患者因宫颈癌（198 人中有 118 人，占 59.6%）、子宫癌（198 人中有 36 人，占 18.2%）和卵巢癌（198 人中有 29 人，占 14.6%）接受了根治性子宫切除术。119 名患者（198 人中有 119 人，占 60.1%）在出院前接受了 TOV 治疗，其中 119 人中有 14 人（11.8%）治疗失败。在出院后TOV患者中（198人中有79人，占39.9%），79人中有5人（6.3%）失败。出院前TOV失败的患者比例在非劣效范围内（差异为5.4%，P = 0.23）。出院后TOV组中出现长期新排尿功能障碍的患者比例更高（差异为27.2%，p = 0.005）。出院前TOV组诊断出新的排尿功能障碍的中位时间为0.5年（范围0-9），而出院后TOV组为1.0年（范围0-6）（P > 0.05）：在这项研究中，出院前 TOV 的短期疗效并不差，长期疗效也有所改善。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Urogynecology Journal 医学-妇产科学

CiteScore

3.80

自引率

22.20%

发文量

406

审稿时长

3-6 weeks

期刊介绍： The International Urogynecology Journal is the official journal of the International Urogynecological Association (IUGA).The International Urogynecology Journal has evolved in response to a perceived need amongst the clinicians, scientists, and researchers active in the field of urogynecology and pelvic floor disorders. Gynecologists, urologists, physiotherapists, nurses and basic scientists require regular means of communication within this field of pelvic floor dysfunction to express new ideas and research, and to review clinical practice in the diagnosis and treatment of women with disorders of the pelvic floor. This Journal has adopted the peer review process for all original contributions and will maintain high standards with regard to the research published therein. The clinical approach to urogynecology and pelvic floor disorders will be emphasized with each issue containing clinically relevant material that will be immediately applicable for clinical medicine. This publication covers all aspects of the field in an interdisciplinary fashion